A strain of bacteria Klebsiella pneumoniae isolated from an 86-year-old woman with a urinary tract infection, admitted to a hospital in a city in the Northeast region in 2022, proved resistant to all available antibiotic options. The patient died 24 hours after admission to that health center.
A group of researchers supported by FAPESP sequenced the bacteria's genome and compared it with a database of 408 other similar sequences. The result is alarming. This is a strain previously detected in the United States and which was already circulating in Brazil, with a risk of spreading throughout the world.
The results were published in the magazine The Lancet Microbe
“It is so versatile that it adapts to changes in treatment, as it easily acquires other resistance mechanisms not covered by existing drugs or their combinations. It is possible that it will become endemic in health centers worldwide”, warns Nilton Lincopan, professor at the Institute of Biomedical Sciences at the University of São Paulo (ICB-USP) and coordinator of the study.
The researcher coordinates One Health Brazilian Resistance (OneBR onehealthbr.com), a platform that brings together epidemiological, phenotypic data and genomic information on microorganisms classified by the World Health Organization (WHO) as “critical priority”.
This classification includes bacteria with few therapeutic options available and that deserve containment measures to prevent them from being disseminated, in addition to having priority for research and development of new antimicrobials.
The platform has support from FAPESP, the National Council for Scientific and Technological Development (CNPq) and the Bill and Melinda Gates Foundation ( read more at: agencia.FAPESP.br/38186
When they find multi-resistant strains like this, health services must notify local epidemiological surveillance. The patient must be isolated and the team treating him must take extra care not to transmit the bacteria to other patients.
“As an opportunistic pathogen, in patients with normal immunity the bacteria may not even cause disease. But, in people with low immunity, it can cause serious infections. At the hospital level, patients admitted to intensive care units [UTIs] or undergoing treatment for other pathologies may acquire a secondary infection, such as pneumonia. Without available treatments and with a depressed immune system, they can often die”, says the researcher.
Favored by the pandemic
The authors note that strains that co-produce carbapenemases (enzymes capable of hydrolyzing antimicrobial compounds) like this one, resistant to all beta-lactams, the most used class of antibiotics, began to be widely detected during the Covid-19 pandemic in Latin American countries. and Caribbean.
The findings generated an epidemiological alert by the Pan American Health Organization (PAHO) and the WHO. A global genomic analysis published recently by a group led by Fábio Sellera, professor at the Metropolitan University of Santos, also recorded a rapid evolution of these bacteria, highlighting a new resistance trend and a serious public health problem.
The latest generation medicine ceftazidime/avibactam, indicated for the treatment of bacteria critical to health, such as K. pneumoniae carbapenemase producer (KPC), was released by the North American Drug Regulatory Agency (FDA) in 2015.
Your approval registration by the National Health Surveillance Agency (Anvisa) occurred in 2018, due to the large number of infections registered by KPC.
“Most likely, hospitalizations for Covid-19 associated with secondary infections with this type of bacteria led to a global increase in the use of ceftazidime/avibactam, favoring the emergence of strains resistant to this new antibiotic,” says Lincopan.
The standard procedure would be for patients admitted with suspected bacterial infection to have their clinical material collected to confirm the diagnosis and susceptibility to the different antimicrobials available to be tested.
“Probably, KPC-producing strains treated with ceftazidime/avibactam evolved quickly, acquiring resistance mechanisms to this last therapeutic option. Now, we have strains that co-produce carbapenemases that do not respond to beta-lactam treatment”, he laments.
In addition to permanent monitoring of bacterial strains found in hospitals, researchers highlight the importance of rational antibiotic prescription. Currently, the OneBR platform has 700 genomes of human and animal pathogens in its database.
For patients, the message is that when you have antibiotics prescribed for you, follow through with the treatment, even if you feel fine after two or three days. The practice also prevents the emergence of resistant strains.
The work, whose first author was doctoral student Felipe Vásquez Ponce, from ICB-USP, was also supported through a doctoral scholarship for Johana Becerra at the same institution.
The article Global epidemiological trends Klebsiella pneumoniae ST340: emergence of subclade KL15 co-producing K pneumoniae carbapenemase-2 and New Delhi metallo-β-lactamase-7 in the Americas is available at: www.sciencedirect.com/science/article/pii/S2666524724002581
This content was originally published in Superbug that poses a global health risk is detected in the Northeast on the CNN Brasil website.
Source: CNN Brasil